Nonspinal Electrical Bone Growth Stimulation (EBGS)

Electrical stimulation of a non-united fracture is a procedure whereby electrodes are placed either at the fracture site (invasive/operative) (20975) or around the fracture site (noninvasive/non-operative) (20974). Electrical current is delivered to the fracture promoting osteogenesis within the previously non-united fracture.

Both invasive and noninvasive nonspinal electrical bone growth stimulation are eligible for payment in the treatment of a non-united fracture. A non-united fracture is defined as a fracture that has not healed within a minimum of three months of the original fracture.

Noninvasive, nonspinal electrical bone growth stimulation may be considered medically necessary as a treatment of fracture nonunion or congenital pseudoarthrosis in the appendicular skeleton (the appendicular skeleton includes the bones of the shoulder girdle, upper extremities, pelvis and lower extremities). The diagnosis of nonspinal fracture nonunion or congenital pseudoarthrosis must meet ALL of the following criteria:

• At least three (3) months have passed since the date of the fracture; and,
• Serial radiographs have confirmed that no progressive signs of healing have occurred; and,
• The fracture gap is one (1) centimeter or less; and,
• The patient can be adequately immobilized and is of an age likely to comply with non-weight bearing.

Nonspinal Electrical Bone Growth Stimulation (EBGS) will be denied as not medically necessary if the preceding criteria are not met.

When the doctor reports electrical stimulation, the claim should be processed under the appropriate code for electrical stimulation (codes 20974-20975). Use of the device is included in the doctor's global allowance for the electrical stimulation (i.e., no separate payment can be made for the device). A participating, preferred, or network provider cannot bill the member for the device itself.

However, if the patient employs the stimulator at home, rental or purchase of the device (code E0747) may be eligible for payment. In this instance, any charges reported by the doctor for electrical stimulation should be denied as not medically necessary.

Re-casting is considered part of the global surgical allowance for the stimulation. Therefore, re-casting is not eligible for separate payment.

For ultrasound stimulation see Medical Policy Bulletin E-35.

EBGS and Spinal Fusion
Electrical bone growth stimulation of the spine is considered medically necessary as an adjunct to lumbar spinal fusion surgery for members who are considered high-risk for spinal fusion failure when any of the following criteria is met:

• A multiple-level fusion entailing 3 or more vertebrae (e.g., L3 to L5, L4 to S1, etc.), or
• Grade II or worse spondylolisthesis, or
• One or more failed fusions, or
• One or more of the following risk factors for fusion failure are present:
  • gross obesity (BMI greater than 40),
  • current smoking,
  • diabetes,
  • renal disease, or
  • active alcoholism
  • chronic long-term steroid use

Electrical bone growth stimulation is considered not medically necessary as an adjunct to cervical fusion surgery and/or for failed cervical spine fusion.

Invasive EBGS of the spine should be reported under code 20975 and processed in accordance with multiple surgery payment guidelines.

As an adjunct to spinal fusion surgery, noninvasive EBGS can begin within 30 days after the most recent fusion procedure. As a nonsurgical salvage for pseudoarthrosis, EBGS can be applied after a minimum of six months (after surgery) has passed. Noninvasive EBGS of the spine should be reported under code 20974.

However, if the patient employs the stimulator at home, coverage for the rental or purchase of the device (code E0748) is determined according to individual or group customer benefits. In this instance, any charges reported by the doctor for EBGS of the spine should be denied as not medically necessary.

Services that do not meet the medical necessity criteria on this policy will be considered not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

Description

EBGS and Spinal Fusion
Spinal fusion has been used to restore stability in a number of congenital, acquired, and degenerative spinal disorders. Failure to obtain spinal fusion has persisted over the years as a relatively common problem.

Electrical bone growth stimulation (EBGS) of the spine is a procedure which promotes the healing process by applying a direct electrical current to the spine. EBGS of the spine can be performed as an invasive or noninvasive procedure, depending on the needs of the patient.

Invasive EBGS of the spine involves the insertion of a bone stimulation device directly into the area of spinal surgery after the fusion procedure has been completed.

Noninvasive EBGS of the spine is a procedure which involves the use of an external power supply and externally applied coils which generate a current through the site where bone growth is desired.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

08/2001, Electrical bone growth stimulation eligible for non-union fractures
10/2010, Coverage guidelines for electrical bone growth stimulation (EBGS) modified

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BCBSA National Policy Reference Manual 7.01.07. 2009.